Background: As the diabetes (DM) epidemic in Canada continues to grow, the need to provide diabetes self-management education (DSME) becomes increasingly important. Research has shown that DSME can improve both physiological and behavioural outcomes in individuals with DM. Diabetes educators (DE) play an essential role in providing DSME to individuals with DM. Although considered an important role in the care of individuals with DM, the DE role is not well described in Ontario. Building a province-wide description of DEs’ role would outline the role of DE in Ontario is enacted, and suggest possible areas for improvement. The specific objectives of this study are: a) To describe the demographic characteristics of DEs in Ontario; b) To identify the structures, processes, and outcomes associated with the role of DEs; c) To identify the facilitators and barriers to providing DSME in Ontario; d) To identify the association between key characteristics of DEs (profession, education, certification, practice-setting, and DM-specific training) and the structures, processes and outcomes of this role. Methods: This cross-sectional study used an online questionnaire, the Diabetes Educator Questionnaire (DEQ). The DEQ was developed using the International Standards for Diabetes Education and Donabedian’s framework to examine the structures, processes and outcomes associated with the role of DEs. The study consisted of three sequential phases: (1) pre-testing the questionnaire in a tertiary care diabetes program, (2) pilot testing the questionnaire to a single Diabetes Educator Section (DES) chapter of the Canadian Diabetes Association (CDA), and (3) administering the DEQ to the remaining DES chapters across Ontario. The online questionnaire was created using LIME survey, an open source survey program housed at McMaster University. Data were downloaded, cleaned, and analyzed using statistical and geographical mapping software. Results: The DEQ demonstrated both face and content validity. A total of 178 out of an estimated 600 DEs across Ontario responded to the DEQ, for an overall response rate of 30%. The respondents consisted of 61 registered nurses, 94 registered dietitians, 18 pharmacists, and 4 nurse practitioners, and 1 undescribed. The majority (85%) of respondents were CDEs. Insufficient time, and organizational/management support were the two most common barriers to implementation of the role of the DE. Significant differences (p value greater than 0.05) in how DSME was provided and the use of outcomes were observed for profession, level of education, and practice setting. Limitations: With a low response rate, conclusions cannot be drawn from this study. Being an anonymous study, intra-rater reliability could not be performed. Conclusions: This study shows that the DEQ serves as a feasible tool to explore the role of DEs in Ontario, however, improved recruitment strategies are necessary before further research is performed. The study provides a foundational description of DEs across Ontario, generating possible hypotheses for future research. / Thesis / Master of Science in Nursing (MSN)

This paper explores what attributes are important for the creation of environment art tools. The purpose of this is to make sure that when a tool is to be developed, it will be done properly within a given time frame. This is important since the cost of tool development is high in both time and capital spent. Being able to make sure that when those resources are spent, that the resulting tool is of high quality and solving the problem which the development team set out to do. Through interviews, forms and the creation of our own tool I hope to find these attributes and to be able to provide insights into how a studio or team might apply them for their own purposes.

Through collaboration between the Substance Abuse and Addiction Recovery Alliance (SAARA) and several community partners, a need was identified for a new measurement tool to gather comprehensive client histories for program evaluation and development. The purpose of this study was to (1) develop a culturally relevant and organizationally appropriate mechanism for the collection of comprehensive client histories and (2) to provide the opportunity for staff to engage in a new process of developing and implementing data collection strategies. As a result of the use of a community-based participatory approach, (1) a missed opportunity for program evaluation and development was identified, (2) a community-based research study was developed, (3) staff were invested in development of the tool, and (4) staff engaged in a capacity-building exercise in which they were provided the skills and tools needed to replicate this process independently in the future.

<div> <p>Fluorescent proteins and the biosensors created with them have been used extensively to monitor chemical species inside and outside of the cell. They have been used to increase our knowledge of cellular function in normal and diseased states. Fluorescent biosensors are advantageous because they can be genetically encoded, do not require exogenous reagents, and can be quantitative. Fluorescent biosensors are also able to measure analytes with high spatial and temporal resolutions, enabling measurements at the scale of physiological events. In this thesis efforts have made to increase the available fluorescent biosensor tools for imaging cellular events. This work includes creation of new sensors for two molecules not yet detectable via fluorescent protein biosensor, acetylcholine and adenosine diphosphate. Efforts were also made to improve the current available biosensors for adenosine triphosphate and cellular redox, to make them more compatible with multiplex and deep tissue imaging. Here I present my work to design, characterize and utilize these fluorescent biosensors.</p> </div> <br>

Educators are divided with regards to the value of computer technology as a learning tool. Some maintain that computers have had little impact on students’ learning; others suggest that computers have the potential to enhance learning. Within this second group there are those who believe that computers are having a significant impact, while others believe that their potential is yet to be realised. The purpose of this study was to examine the relationship between students working in a technology rich environment and their development of higher order, critical and creative, thinking skills. Staff and students from one school participated in this case study. Data were collected by teachers as part of the normal teaching-learning program, supplemented by classroom observations and teacher interviews. In addition, data pertaining to the technology infrastructure was collated from school databases. The data were used to determine the degree of correlation between factors of the learning environment and the extent to which higher order thinking skills (HOTS) were demonstrated by the students. Collations of the statistically significant, and statistically insignificant, correlations allowed relationships between environmental factors and HOTS to be established. / The results indicate that studying within a technology-rich learning environment improves students’ higher order thinking skills, determined by measuring their critical and creative thinking. Factors such as length of time spent in the environment have a positive, non-linear effect on the development of critical thinking skills. These factors have no significant correlation with the development of creative thinking skills. The interaction of students’ computer skills and the classroom environmental factors was shown to be complex. Three-dimensional correlations were performed to derive equations that explain these interactions. Students with better developed computing skills scored higher on critical and creative thinking activities. This was most significant for students with better computer programming skills and the ability to competently manipulate Boolean logic. The most significant factors in developing higher order thinking skills were the students’ levels of computer skills, tempered with their attitudes towards computers and computer classes, and the teacher-student relationships within the technology-rich learning environment. The research suggests that in order to develop students' higher order thinking skills schools should endeavour to integrate technology across all of the learning areas. This will allow students to apply technology to the attainment of higher levels of cognition within specific contexts. This will need to be paralleled by providing students the opportunity to develop appropriate computer skills.

Att sjuksköterskor ställer giltiga omvårdnadsdiagnoser är betydelsefullt för att patienter ska få den omvårdnad som de behöver. Trots att denna förmåga är något som sjuksköterskeutbildningen är ålagd att utrusta blivande sjuksköterskor med är omvårdnadsdiagnostisk förmåga inte utrett hos sjuksköterskestudenter. Inget verktyg för att mäta denna förmåga finns tillgänglig i Sverige idag. Syftet med denna metodologiska studie var att utveckla ett verktyg som avsåg mäta omvårdnadsdiagnostisk förmåga. Genom kognitiva intervjuer, i dialog med experter samt genom att studenter och sjuksköterskor testade att genomföra en omvårdnadsdiagnostisk uppgift utifrån två patientfall utvecklades verktyget stegvis. Verktyget validerades mot omvårdnadslitteratur och mätinstrument samt mot en expertgrupp. Förutom den omvårdnadsdiagnostiska uppgiften utgjordes verktyget även av ett poängsättningsformulär, manual samt en rättningsmall. Studien frambringade ett verktyg som var känsligt för kunskapsvariationer och föreföll ha utrymme för förbättrade resultat. Poängsättningsformuläret med tillhörande manual och rättningsmall visade en hög reliabilitet. Det framtagna verktyget mäter förmågan att urskilja relevanta kännetecken, göra en analys av kännetecken och etiologi samt att rubricera diagnosen; d.v.s. analytisk förmåga, logiskt resonemang och till viss del yrkeskunnande i omvårdnad. Omvårdnadsdiagnostisk förmåga utgörs av fler delförmågor och alla dessa går inte att mäta med det framtagna verktyget. / The fact that nurses identify valid nursing diagnoses is important in order for patients to recieve the nursing care they need. Even though it is imposed on the nurse education to equip the future nurses with this ability, diagnostic competency in nursing isn’t tested among nurse students. There is in Sweden today no tool available for measuring diagnostic competency. The aim of this methodological study was to develop a tool that indended to measure diagnostic competency in nursing. The tool was developed gradually through cognitive interviews, in dialogue with experts and by having students and nurses complete a test in nursing diagnostics based on two case studies. The tool was validated in relation to nursing literature and measuring instruments along with an expert group. In addition to the test in diagnostic competency, the tool was also constituted of a point form, a manual for awarding points and a correcting model. The study created a tool that was sensitive for variations in knowledge within the test group and that seemed to have room for improved results. The point form, the manual for awarding points and the correcting model showed a high reliability. The abilities that the tool measure is the capability to distinguish relevant characteristics, make an analysis of the characteristics and the etiology together with labeling the diagnosis; i.e. analytic ability, logical reasoning and to some extent professional skills in nursing. Diagnostic competency embodies several different abilities and all of these can’t be measured by the developed tool.

Engineered cellular systems are a promising avenue for production of a wide range of useful products including renewable fuels, commodity and specialty chemicals, industrial enzymes, and pharmaceuticals. Achieving this breadth of biological products is facilitated by the diversity of organisms found in nature. Using biological and engineering principles, this diversity can be harnessed to make efficient and renewable bio-based products. Such advancements rely upon our ability to modify host genetics and metabolism. This work focuses on the development of new biotechnological tools which enable cellular engineering, and the implementation of these tools in eukaryotic systems. Mammalian cell engineering has important implications in protein therapeutics and gene therapy. One major limitation, however, is the ability to predictably control gene expression. We address this challenge by examining critical aspects of gene expression in human cells. First, we evaluate the impact of selection markers, a common mammalian expression element, on cell line development. In doing so, we determine that Zeocin is the best selection agent for human cells. Next, we identify loci across the genome that support high level expression of recombinant DNA and demonstrate their advantage for stable integration. Finally, we optimize a Cre recombinase based methodology that enables efficient retargeting of genomic loci. Collectively, this work augments the current genetic toolbox for human cell lines. Beyond basic gene expression, there is interest in understanding global interactions within the cell and how they relate to phenomena including gene regulation, expression and disease states. Although our tools are not yet sufficient to study these phenomena in many hosts, methods can be developed in lower eukaryotes and then adapted for more complex hosts later. We demonstrated two methods in S. cerevisiae that utilize a systems-level approach to understand complex phenotypes. First, we developed condition-specific codon optimization that utilizes systems biology information to optimize gene sequence in a condition-specific manner. Additionally, we developed a Graded Dominant Mutant Approach which can be used to dissect multifunctional proteins, understand epigenetic factors, and quantitatively determine protein-DNA interactions. Both can be implemented in many cellular hosts and expand our ability to engineer complex phenotypes in eukaryotic cell systems.

Indiana University-Purdue University Indianapolis (IUPUI) / An increase in the awareness of environmental conservation is leading the automotive industry into the adaptation of alternatively fueled vehicles. Electric, Fuel-Cell as well as Hybrid-Electric vehicles focus on this research area with the aim to efficiently utilize vehicle powertrain as the first step. Energy and Power Management System control strategies play a vital role in improving the efficiency of any hybrid propulsion system. However, these control strategies are sensitive to the dynamics of the powertrain components used in the given system. A kinematic mathematical model for Plug-in Hybrid Electric Vehicle (PHEV) has been developed in this study and is further optimized by determining optimal power management strategy for minimal fuel consumption as well as NOx emissions while executing a set drive cycle. A multi-objective optimization using weighted sum formulation is needed in order to observe the trade-off between the optimized objectives. Particle Swarm Optimization (PSO) algorithm has been used in this research, to determine the trade-off curve between fuel and NOx. In performing these optimizations, the control signal consisting of engine speed and reference battery SOC trajectory for a 2-hour cycle is used as the controllable decision parameter input directly from the optimizer. Each element of the control signal was split into 50 distinct points representing the full 2 hours, giving slightly less than 2.5 minutes per point, noting that the values used in the model are interpolated between the points for each time step. With the control signal consisting of 2 distinct signals, speed, and SOC trajectory, as 50 element time-variant signals, a multidimensional problem was formulated for the optimizer. Novel approaches to balance the optimizer exploration and convergence, as well as seeding techniques are suggested to solve the optimal control problem. The optimization of each involved individual runs at 5 different weight levels with the resulting cost populations being compiled together to visually represent with the help of Pareto front development. The obtained results of simulations and optimization are presented involving performances of individual components of the PHEV powertrain as well as the optimized PMS strategy to follow for a given drive cycle. Observations of the trade-off are discussed in the case of Multi-Objective Optimizations.

No description available.

The failure to translate evidence into clinical practice has been repeatedly highlighted. This failure is partly attributed to disregarding the context within which healthcare is delivered. The aim of this thesis was to develop and psychometrically evaluate the Context Assessment for Community Health (COACH) tool, and, through that process, provide opportunities to measure aspects of context perceived to be important for Knowledge Translation (KT) interventions in low- and middle-income countries (LMIC). All four studies in this thesis were mainly undertaken in Quang Ninh province, Vietnam during 2008–2014. Study II, however, was also conducted in four other LMICs (Bangladesh, Nicaragua, South Africa, and Uganda). Study I employed inductive content analysis of 16 focus group discussions to explore the influence of context in a community-based facilitation intervention in Vietnam. Studies II and III reported on the development of the COACH tool and assessment of its psychometric properties. Study IV used the COACH tool in a survey among health workers in Vietnam. To date, three sources of evidence regarding validity of the COACH tool have been provided, that is, test content, response processes, and internal instrument structure, with promising psychometric characteristics. The COACH tool could be used as means of characterizing aspects of context ahead of KT interventions, for tailoring KT strategies, and for further understanding of the results of KT interventions. / Context Assessment for Community Health